Provider Demographics
NPI:1164115457
Name:SINGH, GURJODH (PA)
Entity Type:Individual
Prefix:
First Name:GURJODH
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E JAMES PL
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-1227
Mailing Address - Country:US
Mailing Address - Phone:732-391-7077
Mailing Address - Fax:
Practice Address - Street 1:216 E JAMES PL
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-1227
Practice Address - Country:US
Practice Address - Phone:732-391-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00780100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant